Quebec's end-of-life bill puts Canada at a 'crossroads'

Toronto health lawyer Mary Jane Dykeman says Quebec’s new end-of-life-care bill puts Canada at a “crossroads” in the long-standing public debate about physician-assisted suicide and advances the contentious issue.

“Quebec has taken a position that many Canadians have talked about for a long time and, as a result, they have taken the dialogue that much further,” she tells AdvocateDaily.com. “It’s a new frontier.”

The existence of the Quebec bill will likely “focus the discussion” as never before in Canada and will serve as a stepping off point for the country to more pointedly engage in the issue of end-of-life choice.

Dykeman, partner at Dykeman Dewhirst O’Brien LLP, anticipates provincial and territorial governments and those who work in the health sector across the country will watch closely to see how the new legislation works in Quebec.

“The legislation is one thing – it’s how it’s operationalized and what protections are built in and the oversight that people want,” she says. “It’s a very thoughtful bill, whether you agree with it in principle. The federal government will be doing its own analysis of the bill and the provinces and territories will be watching very carefully to see whether they too want to cross the precipice.”

Dykeman notes that the federal government will most certainly weigh the merits of a legal challenge to the Quebec legislation.

“Now that Bill 52 is law in Quebec, Ottawa will consider its response, given the division of powers issue the bill creates between the two levels of government – is this a health law matter or a criminal law matter," she asks.

Bill 52, also known as an act respecting end-of-life care, passed in the National Assembly in Quebec City, says CBC News. The legislation allows a doctor who has been given the consent of the patient to administer medication to cause death.

Quebec’s new law places the province alongside other jurisdictions that allow for physician-assisted suicide, including European countries such as Belgium, the Netherlands and Switzerland, as well as Australia’s Northern Territory and a few American states.

The lawyer notes it’s critical for Ontario health practitioners to understand the law as it exists today in this province when it comes to end-of-life decisions, including withholding and withdrawal of proposed treatment.

In Ontario, practitioners are bound by the Health Care Consent Act, which sets out a broad definition of treatment and lays out the legal requirements for practitioners as they pertain to the wishes and consent of patients (and the role of an incapable patient’s substitute decision-maker to give effect to the patient’s wishes or provide consent to a plan of treatment). A plan of treatment allows a capable patient (or if incapable, substitute decision-maker) to provide consent to withhold or withdraw treatment in future, based on the patient’s current health condition.

“There are tools that exist to accord with peoples’ wishes and with direct consent to withdraw or withhold certain treatments in the future – that’s already built into the act,” she says.

But Dykeman notes the Quebec end-of-life-care act obviously takes that a step further to allow patients to actively seek and receive medical aid for dying, to themselves propose treatment that will hasten death and the act authorizes provision of such medical aid by a health practitioner.

“The Quebec legislation is enshrined in the request of the patient for medical aid in dying,” she says. "Whether it is a welcome and compassionate advance for terminally ill patients or a nod to better prioritize the provision of palliative care is as yet undetermined."